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Family Med EOR > Desquamation, Acneiform Lesions, & Other Dermatologic Conditions > Flashcards

Desquamation, Acneiform Lesions, & Other Dermatologic Conditions Flashcards

1
Q

What causes Steven-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)?

A

MC after drug eruptions, esp. sulfa & anticonvulsant meds*, NSAIDs, allopurinol, abx

Less common: mycoplasma, HIV, HSV, malignancy

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2
Q

What is the difference btwn SJS & TEN?

A

SJS = sloughing < 10% of BSA

TEN = sloughing > 30%, may develop skin necrosis

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3
Q

What are s/s of SJS & TEN?

A

Fever & URI sx –> widespread blisters begin on trunk/face, erythematous/pruritic macules ≥ 1 MM involvement w/ epidermal detachment* (+ Nikolsky sign)

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4
Q

How do you treat SJS & TEN?

A

Treat like severe burns

Burn unit admission, pain control, withdrawal of offending meds, fluid/electrolyte replacement, wound care

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5
Q

What causes pemphigus vulgaris?

A

Autoimmune d/o 2ndary to desmosome disruption

*Desmosomes hold the skin together

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6
Q

What are s/s of pemphigus vulgaris?

A

Oral MM erosions & ulcerations –> painful flaccid skin bullae (rupture & bleed easily)

Nikolsky sign: SF detachment of skin under pressure/trauma

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7
Q

How do you diagnose pemphigus vulgaris?

A

Skin biopsy, direct immunofluorescence (IgG throughout the epidermis)

ELISA

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8
Q

How do you treat pemphigus vulgaris?

A

High dose corticosteroids 1st line

Methotrexate, azathioprine, cyclophosphamide

Local wound care, abx

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9
Q

What is bullous pemphigoid?

A

Chronic widespread autoimmune blistering skin disease primarily of the elderly

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10
Q

What are s/s of bullous pemphigoid?

A

Urticarial plaques –> tense bullae (don’t rupture easily)

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11
Q

What distinguishes bullous pemphigoid from pemphigus vulgaris?

A

Subepidermal involvement

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12
Q

How do you treat bullous pemphigoid?

A

Systemic corticosteroids, antihistamines

Immunosuppressants

If mild –> topical corticosteroids

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13
Q

What is melasma? What causes it?

A

Hypermelanosis of sun exposed areas

Increased estrogen (OCPs, pregnancy), sun exposure

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14
Q

What does melasma look like?

A

Hypermelanotic symmetrical macules esp on face/neck

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15
Q

How do you diagnose melasma?

A

Wood’s lamp: appearance is unchanged

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16
Q

How do you treat melasma?

A

Sunscreen

Topical bleachers: Hydroquinone, azelaic acid

Topical retinoids, chemical peels

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17
Q

What is vitiligo?

A

Autoimmune destruction of melanocytes –> skin depigmentation

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18
Q

What are s/s of vitiligo?

A

Irregular discrete macules & patches of total depigmentation

Dorsum of hands, axilla, face, fingers, folds, genitals

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19
Q

How do you treat vitiligo?

A

Localized: topical corticosteroids
Facial: Calcineurin inhibitors
Disseminated: Systemic phototherapy
Laser, grafts

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20
Q

What type of hsn reaction leads to urticaria (hives)? What are triggers?

A

Type I (IgE) or complement-mediated. Mast cells release histamine.

Foods, meds, infections, insect bites, environment, stress, heat/cold

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21
Q

What does urticaria look like?

A

Blanchable, edematous pink papules, wheals or plaques that may coalesce

Often disappear after 24 hrs

Dermatographism: local pressure –> wheals to that area

Darier’s sign: urticaria appearing where skin is rubbed

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22
Q

How do you treat urticaria?

A

Oral antihistamines = tx of choice!

Corticosteroids, H2 blockers

23
Q

What are the 4 main pathophysiologic factors of acne vulgaris?

A
  1. Increased sebum production due to increased androgens
  2. Clogged sebaceous glands
  3. Propionibacterium acne overgrowth
  4. Inflammatory response
24
Q

What are the s/s of acne vulgaris?

A
  1. Comedones (open/incomplete blockage = blackheads, closed/complete blockage = whiteheads)
  2. Inflammatory: papules or pustules
  3. Nodular or cystic acne: often heals w/ scarring
25
Q

How do you diagnose acne vulgaris?

A

Mild: comedones (+/- small amt of papules/pustules)

Mod: comedones, larger amt of papules/pustules

Severe: nodular (> 5mm) or cystic

26
Q

How do you treat mild acne vulgaris?

A

Topical retinoids, benzoyl peroxide, topical abx, OCPs

27
Q

How do you treat moderate acne vulgaris?

A

Same as mild + oral abx (doxycycline or minocycline, macrolides)

+/- anti-androgen agents (spironolactone)

28
Q

How do you treat severe acne vulgaris?

A

Isotretinoin

29
Q

What causes rosacea? What are triggers?

A

Unclear, MC in males. Demodex mite?

Etoh, increased temp, hot drinks, hot/cold weather, hot baths, spicy food, meds

30
Q

What are s/s of rosacea?

A

Acne-like rash + erythema, facial flushing, telangiectasia, skin coarsening, papulopustules w/ burning, stinging

31
Q

How do you treat rosacea?

A

Topical metronidazole = 1st line

Azelaic acid, ivermectin cream

Sulfacetamide, abx

32
Q

How do you treat mod-severe rosacea?

A

Oral abx, laser, isotretinoin

33
Q

What are lifestyle modifications for rosacea?

A

Sunscreen

Avoid toners, astringents, camphor

34
Q

What is folliculitis? What bacteria causes it?

A

SF hair follicle infection w/ singular or clusters of small papules or pustules w/ surrounding erythema

S. aureus MC

35
Q

How do you treat folliculitis?

A

Topical mupirocin, clinda, erythromycin

If severe/refractory –> oral cephalexin, dicloxacillin

36
Q

What is acanthosis nigricans?

A

Dark, velvety discoloration in body folds & creases

37
Q

What causes acanthosis nigricans?

A

Insulin resistance
Hormone d/o
Drugs/supplements
CA

38
Q

What is the criteria for minor burns?

A

< 10% of TBSA in adults
< 5% of TBSA in young/elderly
< 2% full thickness

39
Q

What is the criteria for major burns?

A 
> 25% of TBSA in adults 
> 20% TBSA in young/old 
> 10% full thickness 
Involving face, hands, perineum, feet
Crossing major joints, circumferential
40
Q

How do you treat burns?

A

Cleansing (For chemical burns, irrigate profusely for at least 20 mins)

Debridement

Pain management: acetaminophen, NSAIDs, opioids

Topical abx: silver sulfadiazine, silvadene CI if sulfa allergic/pregnant/<2 months (avoid face due to discoloration)

Honey, aloe vera

Dressings

Lactated ringers x 1st 24hrs (1/2 in 1st 8hrs, other 1/2 over remaining 16 hrs)

41
Q

Describe a stage I pressure ulcer

A

SF, nonblanchable redness that doesn’t dissipate after pressure is relieved

42
Q

Describe a stage II pressure ulcer

A

Epidermal damage –> dermis. Resembles blister or abrasion

43
Q

Describe a stage III pressure ulcer

A

Full thickness of skin, may extend into SQ layer

44
Q

Describe a stage IV pressure ulcer

A

Deepest. Extends beyond fascia –> muscle, tendon, bone

45
Q

How do you treat pressure ulcers?

A

Wet to dry dressings, hydrogels

I, II: wound care, pain management

III, IV: IV +/- surgical debridement

46
Q

What are lipomas? Where on the body are they MC?

A

SQ benign tumor of adipose tissue

MC on trunk & extremities

47
Q

What do lipomas look like?

A

Soft, symmetric, painless easily mobile, palpable mass

48
Q

How do you treat lipomas?

A

No tx needed

Cosmetic: surgical removal

49
Q

Describe venous stasis ulcers & ulcers a/w arterial insufficiency

A

See pg 66 of PANCE Prep Pearls

50
Q

What is hidradenitis suppurativa?

A

Chronic abscess of apocrine sweat glands or sebaceous cysts w/ tract formation

51
Q

What does hidradenitis suppurativa look like? Who is it MC in?

A

Red tender inflammatory nodules/abscesses

MC in obese women (axilla, groin, under breasts, anogenital)

52
Q

How do you treat hidradenitis suppurativa?

A

Mild –> clinda, intralesional injections of triamcinolone

Deep, recurrent –> punch debridement, unroofing w/ washout

Abscess –> I&D

Oral tetracycline, cephalosporin, clinda, cipro

53
Q

What are lifestyle changes for hidradenitis suppurativa?

A

Avoid high glycemic foods
Smoking cessation
Local skin care

Family Med EOR (15 decks)

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